Become a Client
In order to better serve our clients, we are now offering our intake forms electronically.
Individuals who are seeking services should look at the sections below and fill out the forms for the program(s) they are interested in. The forms include a large amount of information, some of which may not apply to you. Please answer all applicable questions as thoroughly as possible. Please complete all forms that are under the heading of the service you are interested in. Not completing all forms may delay your request for services.
There is the possibility that due to the nature of some of the questions, a person could have difficulty responding to particular sections. If this occurs, simply fill in as much information as you are comfortable, and you can discuss this more with your intake clinician. If you are actively suicidal, do not complete the paperwork. Seek emergency medical services by calling 911.
Download your forms using the links below.
If you have issues or questions, please email firstname.lastname@example.org for assistance.
In order to fill the forms electronically, you must have a version of Adobe Acrobat installed on your computer. Download Acrobat for free here.
You will also need to create a new Digital ID in order to electronically sign the forms. Please follow instructions in Adobe.
Forms for Counseling and/or Clinical Case Management Services
Forms for Housing Services Only
Intensive Outpatient Program
Once you have completed your forms, please upload them below.
Make sure your forms are saved with this filename format: “FirstNameLastInitial_FileName”
Ex. JohnD_Consent for Emergency Medical Care